Provider Demographics
NPI:1679666598
Name:CARDIOVASCULAR INSTITUTE OF CENTRAL FLORIDA, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR RN
Authorized Official - Phone:352-622-4251
Mailing Address - Street 1:2111 SW 20TH PLACE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-622-4251
Mailing Address - Fax:352-873-3920
Practice Address - Street 1:2111 SW 20TH PLACE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-622-4251
Practice Address - Fax:352-873-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB528OtherMEDICARE PROVIDER NUMBER